Cardiac disease during pregnancy remains a significant cause of maternal morbidity and mortality, particularly in low- and middle-income countries. These conditions may be congenital or acquired, with rheumatic heart disease (RHD) being prevalent in resource-limited settings. Pregnancy imposes profound cardiovascular changes—elevated plasma volume, increased heart rate and stroke volume—that may unmask or exacerbate latent cardiac pathology. Maternal cardiovascular stability is closely linked to fetal well-being. This study evaluates maternal and neonatal outcomes in pregnancies complicated by heart disease in a tertiary care referral centre in Jammu and Kashmir. Despite numerous international studies, there is limited data from Jammu & Kashmir on fetomaternal outcomes in heart disease during pregnancy. Additionally, few regional studies apply the modified WHO (mWHO) classification in risk assessment, which is now an essential component of guideline-based care.

Study design and setting: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Lalla Ded Hospital, Government Medical College, Srinagar, over a 2-year period.

Inclusion criteria: Pregnant women with known or newly diagnosed heart disease.

Exclusion criteria: Pregnancies complicated by other significant comorbidities such as diabetes, chronic renal disease, or severe pulmonary disorders.

Data collection: Patient records were reviewed for demographic details, cardiac lesion type, New York Heart Association (NYHA) functional classification, need for ICU care, mechanical ventilation, cardiovascular complications, delivery mode, and neonatal outcomes. Definitions: Preterm birth was defined as delivery before 37 completed weeks of gestation. Cardiovascular complications included arrhythmias, acute heart failure, thromboembolic events, and other serious cardiac events during pregnancy or postpartum. Ethics: The study was approved by the Institutional Ethics Committee of Government Medical College, Srinagar, with a waiver of informed consent due to its retrospective nature. Statistical analysis: Data were analysed using SPSS version 25.0. Categorical variables were presented as frequencies and percentages with 95% confidence intervals (CIs).

Table 1: Age distribution of study subjects

Table 2: Distribution of cardiac lesions

Table 3: Maternal outcomes

Table 4: Perinatal outcomes (corrected)

In our study, rheumatic heart disease (RHD) was the most common cardiac lesion, accounting for 32.78% of cases, followed by peripartum cardiomyopathy and arrhythmias. This pattern is consistent with the reports by Hameed et al. (2001) and Sawhney et al. (2003), where RHD was also the predominant lesion in pregnant women in developing countries. In contrast, Siu et al. (2001) and other studies from high-income countries have found congenital heart disease to be the leading cause, reflecting differences in healthcare systems, early diagnosis, and rheumatic fever prevalence.

The ICU admission rate in our series (36.06%) was similar to the 34% reported by Hameed et al., and slightly higher than the 28% reported by Siu et al. Mechanical ventilation was required in 14.75% of our patients, which aligns with the 12–15% range reported in tertiary-care cohorts such as that described by Regitz-Zagrosek et al. (2011). Cardiovascular complications occurred in 18% of cases in our study, closely matching the 20% complication rate observed by Siu et al., and within the range described by Elkayam et al. (2005) in women with peripartum cardiomyopathy.

No maternal mortality was recorded in our cohort, whereas Silversides et al. (2010) reported mortality rates of 1–3% depending on lesion severity. The absence of maternal deaths in our study may be attributed to timely risk stratification, early referral, vigilant antenatal monitoring, and delivery in a tertiary setting with access to multidisciplinary cardio-obstetric and critical care support.

In terms of perinatal outcomes, our preterm birth rate was 16.4%, which is lower than the 35–45% reported in large multicentre cardiac pregnancy cohorts by Regitz-Zagrosek et al., and also lower than the 25% reported by Pijuan-Domenech et al. (2014). This lower rate could be explained by the relatively stable NYHA status in most of our participants and proactive delivery planning. The NICU admission rate (16.4%) was comparable to the 15–20% range found in other Indian series such as Sawhney et al., and slightly lower than that seen in Western cohorts where prematurity rates are higher.

Neonatal mortality in our series was 3.3%, closely matching the 2–4% reported by Adams et al. (2002). Importantly, no congenital heart defects were identified in any newborn, which supports the findings of Adams et al. that most maternal cardiac lesions without genetic basis do not significantly increase the risk of congenital heart disease in offspring.

Overall, our results compare favourably with both national and international literature. The relatively low maternal and neonatal adverse event rates reinforce the effectiveness of early diagnosis, careful antenatal surveillance, risk-based management, and delivery in tertiary care centres. These findings underscore the need for structured cardio-obstetric care pathways to optimise outcomes in pregnancies complicated by heart disease.

Pregnancy complicated by heart disease poses substantial risk, yet good outcomes are attainable with proactive, guideline‑directed care. In our series, despite considerable need for critical care, there were no maternal deaths and perinatal outcomes were acceptable, with a preterm birth rate of 16.4%. Embedding mWHO‑based risk stratification, lesion‑specific management, and multidisciplinary delivery planning within tertiary centres can further improve fetomaternal outcomes. We recommend routine incorporation of mWHO risk assessment into antenatal booking visits, establishment of regional cardio-obstetric clinics, and training programs to enhance multidisciplinary management capacity.

LIMITATIONS

Retrospective design and modest sample size limit generalisability; NYHA class‑stratified analysis and long‑term maternal/neonatal follow‑up were not available.

RECOMMENDATIONS

Routine preconception counselling for women with known heart disease, establishment of dedicated cardio‑obstetrics clinics, and prospective multicentre studies to refine risk models and optimise care pathways.

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